Left bundle branch area pacing in patients with transthyretin cardiac amyloidosis: a case series.

Abstract

Background: Transthyretin cardiac amyloidosis is associated with various arrhythmias, including atrioventricular block. Despite this correlation, established treatments for transthyretin cardiac amyloidosis-associated arrhythmias are lacking. Left bundle branch area pacing is a promising physiological pacing technique.

Case summary: This case series describes three instances of successful left bundle branch area pacing in patients with transthyretin cardiac amyloidosis presenting with atrioventricular block. Despite significant ventricular septal hypertrophy across all cases, left bundle branch area pacing was implemented effectively without complications.

Discussion: Traditional pacing strategies in transthyretin cardiac amyloidosis, such as right ventricular pacing, have been associated with a reduced left ventricular ejection fraction and worsening heart failure. Although biventricular pacing has been explored, the supporting evidence remains limited and inconclusive. Recent studies have suggested that left bundle branch area pacing poses a lower risk of inducing heart failure than biventricular pacing. Our findings support the safety and efficacy of the left bundle branch area pacing in patients with transthyretin cardiac amyloidosis-related atrioventricular blocks and underscore its viability as a pacing strategy.